KCER Ready!

2.Please complete the questions below to assess your facility's disaster readiness.

1.Please select your type of organization. You may select more than one.

Dialysis

Transplant

Hospital

Other healthcare provider

Patient Organization (NKF, AAKP, etc)

Healthcare Provider Organization (ANNA, ASN, etc)

ESRD Network

Other Government Affiliation (CMS, CDC, etc)

Other

2.In the past year, has your facility/organization communicated directly with your local emergency management agency?

Yes

3.Do you know about your local government’s emergency or disaster plan for your community?

Yes

4.Do you know how to find the emergency broadcasting channel on the radio or television?

Yes

5.In the last year, has your facility/organization joined or participated with a local Healthcare Coalition?

Yes

6.In the last year, has your facility’s/organization’s staff complied with the CMS Emergency Rule training exercise requirements?

Yes

7.In the past six months, has your facility/organization provided education to patients on disaster preparedness?

Yes

8.In the past six months, has your facility/organization provided education to staff on disaster preparedness?

Yes

9.In the past six months, has your facility/organization reviewed and updated the disaster plans?

Yes

10.In the last year, has your organization made a specific plan for how you and your staff would communicate with each other and with patients during an emergency situation, including updating contact numbers and addresses?

Yes

11.In the last year, has your facility/organization encouraged patients and staff to prepare a Disaster Supply Kit with emergency supplies like water, food and medicine that is kept in a designated place at home?

Yes

12.Optional Contact Information

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

13.Optional Contact Information